Annals of the M.B.C. - vol. 1° - n° 2 - September 1988

THE ORGANIZATION OF BURN CENTRES IN THE EVENT OF NATURAL CALAMITIES AND DISASTERS

Donati L., Ponzielli G.

Cattedra di Chirurgia Plastica UniversitA degli Studi di Milano
Divisione di Chirurgia Plastica Ricostruttiva
ospedale Niguarda Ca' Granda Milano, Italia


SUMMARY. The socio-economie structure of the modern world generates ever more complex situations and consequently greater numbers of people are involved in calamitous events: life is lived in ever larger "blocks of population" and at the same time man's relationship with Naltire has never been riskier (Chernobyl docel).
It is well known that the care ofextensive burns requires special teams that must be sophisticated in terms of both qualified personnel and equipment. No Burn Centre can be structured to cope with the demands arising from a disaster or a natural calamity without enormous overrating of the problem.
The solution can only lie in considering the problem not from a local viewpoint but from a more general viewpoint, in the framework ofa process of global coordination for the more intelligent use of all available resources, through the rapid transfer of equipment, personnel and information, all of which is possible using a telematic service.

It is well known that the National Health Service in Italy is unable to provide satisfactory services even in normal circumstances. The chronic lack of hospital beds, varying unequally from ward to ward, and the established reality of stafT shortages, due to political choices aimed at reducing public expenditure - these synthesize the levels of the problem, which is both economic and organizational.
The telephone ringing away, with somebody seeking a bed that more offen than not is unavailable, the sequence of useless explanations while the sick person -patiently- waits - this smooth-running series
of contradictions that is typical of our present system just an accompaniment to give extra flavour to a television soap opera - it is an everyday reality.
In our opinion many Centres still have gaps in their structure which prevent the creation of any operative protocol in routine situations: it is as if routine situations themselves constituted an emergency. And what about a real emergency'? No comment.
The organization of labour and of leisure time in restricted areas of high demographic density (ever higher skyscrapers, sports stadiums, factories, cinemas, modem means of transport etc.) has extended the dimension of risk from individual to group level. In other words, groups of individuals collectively run the risk of being involved together in disastrous accidents, as if they were one single anatomical unit.
The structure of our society will expose us to greater and greater risks that will be more terrible as
the relationship between man and society becomes inore hazardous (Chernobyl docet).
If we decided to take precautions in view of future possible emergencies by setting up a pool of resources taken from existing facilities, we would certainly fail, considering the subsequent strengthening that would then be necessary, beyond all normal logical limits, of existing structures. These are of course structures of advanced technological character, as regards both equipment and staff.
The solution, to our way of thinking, is elsewhere. It must lie in an attempt at reorganization, which would extend the problem from the local level to the general by involving all national structures - in other words all available resources must be optimized so that the impact of emergency situations may be kept fully under control as they come into contact with the various planned operative structures.
This is now possible with TELEMATICS, a technique enabling us to operate from long distances, thanks to the exchange of information in real time.
Milan, with the active collaboration of Italtel, has already made good progress in this direction, with a project - already at an advanced stage of realization - for a wide network of privileged communication (ITAPAK) between the various Burn Centres in NORTHERN ITALY. But there must be a concerted effort to extend this information network throughout all of Italy. The peninsula could be divided into three operative areas: NORTHERN, CENTRAL and SOUTHERN, each one operating autonomously and able to coordinate and intervene outside its territory when necessary.
The fulcrum of the system must be the operative centre to which calls are made, in each case the nearest Bum Centre which will direct the entire operation.
A fundamental requirement is the setting up of interconnected data banks which will be updated routinely on 'a daily basis with information concerning the availability of beds, the type of beds available, etc.
The operating system must be able to make use of specialized mobile radio units, first aid units, Armed Forces services and Civil Defence units.
In the event of the network of Bum Centres not being adequate to face an emergency, Videotex linkups with temporary field hospitals would make it possible to carry out specialist treatment.
The possibility of speaking simultaneously on the same privileged line to the general operative centre and to the other Bum Centres, using telecast data and pictures (age of patient, extent and depth of bums, associated pathologies etc.), would eliminate all waste of time and guarantee the best possible destination for the patient.
The above plan is in our opinion the essential basis for any modern and forward-looking emergency system.

 

RÉSUMÉ. Le fait que de nombreuses personnes puissent être touchées au cours de graves accidents est, selon la logique des grands nombres, une réalité à craindre de plus en plus, étant donné les structures modernes de la vie socio-économique qui engendre des situations de plus en plus complexes: la vie se développe de plus en plus en "blocs" consistants d'individus; d'un autre côté le rapport entre l'homme et la nature est de plus en plus aléatoire (voir Tchernobyl).
On sait que le traitement des brûlures étendues a besoin d'instruments sophistiqués non seulement en ce qui concerne le matériel proprement dit mais aussi matière de personnel. Aucun Centre de Brûlés ne serait en mesure de répondre aux conséquences d'un désastre ou d'une calamité naturelle sans multiplier le nombre des problèmes.
On ne peut trouver de solution que si on déplace le problème d'une optique locale à une optique plus générale dans le cadre d'une coordination globale pour utiliser de façon plus intelligente toutes les ressources, c'est-à-dire, de pouvoir compter sur un service télématique pour transférer rapidement le matériel, les personnes et les informations.




 

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